Physical and Mental Health Integration

Background

Mental health is a key driver of Medicaid spending. The June 2015 Medicaid and CHIP Payment and Access Commission’s Report to Congress noted that approximately one-in-five Medicaid enrollees lives with a diagnosed mental health condition or substance use disorder. Mental health also drives healthcare utilization. According to the Agency for Healthcare Research and Quality, individuals with mood disorders or schizophrenia and other psychotic disorders represented the top two most common diagnoses for re-hospitalizations among Medicaid beneficiaries in 2011. Individuals with mental health needs often have comorbid physical health conditions that require medical attention; more than half of the Medicaid-enrollees in the top five percent of expenditures who had asthma or diabetes also had a behavioral health condition.

Given the prevalence of mental health conditions in the Medicaid population, the high level of Medicaid spending on behavioral health care, and the adverse impact that uncoordinated care can have on people’s health, initiatives to integrate physical and mental health are a top priority for Medicaid agencies. Integrated care approaches have been shown to improve health outcomes for individuals with behavioral health conditions. Effective integrated care can also enhance patient engagement and activation, which has been shown to be associated with increased treatment adherence, improved patient satisfaction, better quality of life, and increased mental and physical health.

Program Support for State Medicaid Agencies

Beginning in April 2016, the Medicaid IAP collaborated with states to expand and/or improve existing Physical and Mental Health (PMH) integration efforts. Leveraging the expertise of state policy leaders and others in the field, IAP provided participating states with technical support to:

Improve the behavioral and physical health outcomes and experience of care of individuals with a mental health condition(s)

Create opportunities for states to link payments with improved outcomes for Medicaid beneficiaries with these co-morbid conditions

Expand or enhance existing state physical and mental health integration efforts to customize for specific populations and/or spread integration efforts to new areas of the state or to new types of health professionals

As part of this program area, IAP provided technical support to two groups of states. The first group of states, the Integration Strategy Workgroup, consisted of Idaho, Illinois, Massachusetts, and Hawaii. Over the course of an 11 month period, IAP provided these states with focused technical support on two topics of common interest: identifying quality measures to use for integrated care and understanding ways to build provider capacity. Through group webinars and individualized technical support, states worked on diverse integration efforts, including designing value-based payment approaches for PMH integration, promoting PMH integration in rural settings, and supporting care coordination in managed care organization and provider contracts.

In the second IAP PMH integration group, the following states and territory received individualized coaching and technical support for a 12 month period: Nevada, New Hampshire, New Jersey, Puerto Rico, and Washington. IAP coaches met regularly with state teams to assist them in developing and achieving goals specific to their state’s PMH integration work. State teams also participated in group discussions with other states and experts on topics of common interest, including administrative alignment, quality measurement, and value-based payment. Learn more about these four states and territories' Medicaid IAP work.